Wednesday
Oct182017

Elon, Do We Have a Disaster for You!

Elon, Do We Have a Disaster for You!
 

By Kim Bellard, October 18, 2017

 

One of the most interesting twists resulting from Hurricane Maria striking Puerto Rico was Elon Musk's offer that Tesla could help Puerto Rico solve its energy crisis, with a long-term, 21st century fix. 
It is telling that we don't have similar offers to rebuild the Puerto Rico's health care system, which is 
similarly devastated.  Or, for that matter, our system, which is its own kind of disaster.

 

Mr. Musk was asked on Twitter if Tesla could help Puerto Rico using solar and battery power, and he responded in the affirmative, saying it had done so on smaller islands but faced no scalablity issues.  Next thing we knew the Governor of Puerto Rico and he were talking.  Now Tesla is starting to deliver their battery systems to the island, so we'll see.

Maybe it is a marketing stunt on Mr. Musk's part -- if so, you have to give him credit for it -- but the idea has merit.  A disaster like Maria is a once-in-a-lifetime opportunity to try bold new ideas instead of blithely rebuilding what was there before.

Still, even Elon Musk isn't bold enough to offer to rebuild their health care system, much less ours.

Sometimes disasters do make us rethink our health care system.  Katrina, for example, has 
often been credited with creating the impetus for electronic health records (EHRs), since it destroyed countless paper records, wrecking havoc on care for thousands of patients.

But we 
didn't pay enough attention to even that very visible crisis.  We do have a lot more EHRs now, but less than 30% of hospitals self-report being interoperable.

The records themselves remain largely physician-centered and exclusively medical, although Epic, the nation's largest EHR vendor, is 
finally saying they will move to a "comprehensive health record" (CHR). . 

I'm glad that in 2017 EHRs vendors are finally realizing there is health outside a medical facility.

It shouldn't take a hurricane -- or an earthquake, or a bickering Congress -- to realize that we have an in-progress disaster with our health care system. 

Let's say we were starting from scratch.  Let's reset what our health care system could be.  Let's say we didn't have all these hospitals, hadn't trained any physicians, hadn't deployed any medical devices or used any prescription drugs, although we could start with the knowledge of what each of those could accomplish.

Would we remake the system as it is, or would we design something new?

In a previous post I 
enumerated several things about our health care system I was dying to redesign, and in another I gave some specifics about how a re-engineered system might work.  Even those, though, didn't start from entirely scratch, still focusing more on the medical than on the broader health perspective.

We should be spending more on our health needs -- broadly defined -- than on our medical care.  We should be more worried about if people are going to the park than if they are going to the doctor's office.  And when we do get medical care, we should make sure it is care that has solid evidence of working, rather than too often accepting care that might work.

Elon Musk has his hands full 
saving humanity, not to mention helping Puerto Rico, so we probably can't count on him to offer to reinvent our health care system too.  So who will it be?

 

  

This post is an abridged version of the posting in Kim Bellard’s blogsite. Click here to read the full posting

 
Friday
Oct132017

A Dozen Things To Know About The Trump Healthcare Executive Order and Elimination of CSR Payments

A dozen Things To Know About The Trump Healthcare Executive Order and Elimination of CSR Payments
 

by Clive Riddle, October 13, 2017

 

1.       Attorney General Jeff Sessions issued a legal opinion to HHS and the Treasury Department that that money appropriated to HHS “cannot be used to fund” Cost Sharing Reduction (CSR) payments.
 

2.       The Trump administration has filed notice to the U.S. Court of Appeals for the D.C. Circuit, “that the Department of Health & Human Services (HHS) has directed that cost-sharing reduction payments be stopped because it has determined that those payments are not funded by the permanent appropriation for ‘refunding internal revenue collections.” they were not formally appropriated by Congress.
 

3.       Health Plans still have to provide marketplace subsidized discounts to low-income customers. Without CSR reimbursement, one must assume participating plans will raise premiums as soon as feasible.
 

4.       A CBO report indicates the decision to end CSR payment payments is likely to cost the federal government more than making the payments due to ACA required subsidies to cover anticipated premium increases.
 

5.       The health plans most impacted by the CSR elimination include mostly Blue Cross and Blue Shield companies and insurers focused on Medicaid, such as CenteneCorp. and Molina Healthcare Inc.
 

6.       CSR lawsuits are likely. Impacted health plans may sue. The Hill reports attorneys general from California and New York say they are prepared to sue the Trump administration to protect health-care subsidies that the White House said would be cut off.
 

7.       As Sam Baker, Axios healthcare editor posts, “Congress can solve this. University of Michigan law professor Nicholas Bagley, an expert on this issue, told me that if Congress appropriates the money for these subsidies, they would begin flowing again immediately.”
 

8.       The Trump Executive Order does not equate to immediate changes. As healthcare policy expert Timothy Jost posts in Health Affairs, the Executive Order “is a direction to draft rules. Under the Administrative Procedures Act these agencies will first have to publish proposed rules and then receive and respond to public comments before publishing the rules in final form. The fact sheet accompanying the order acknowledges that regulations will proceed through notice and comment rulemaking. This will likely take months. Indeed, rulemaking will likely be proceeded by studies by the affected departments, and any proposed and final rules will likely have to be reviewed by the Office of Management and Budget. Therefore, changes are unlikely to affect plans beginning on January 1 of 2018, although some changes may take effect mid-year.”
 

9.       The executive order instructs the Department of Labor to expand the availability of association health plans under the Employee Retirement Income Security Act of 1974 (ERISA).
 

10.   The executive order instructs the Departments of Labor and HHS to pursue expanded Availability of Short-Term, LimitedDuration Insurance.
 

11.   The executive order instructs the Departments of Labor, Treasury and HHS to increase the usability of HRAs, to expand employers' ability to offer HRAs to their employees, and to allow HRAs to be used in conjunction with nongroup coverage.
 

12.   As Timothy Jost notes in another Health Affairs post, small employers already received expanded ability regarding HRAs in 2016, when “Congress adopted in Title XVIII of the [21st Century] Cures Act a new type of arrangement, the Qualified Small Employer HRA (QSEHRA), that is effectively an exception to the HRA prohibition, but only for small employers — employers that have fewer than 50 full-time equivalent employees and therefore are not subject to the large employer mandates. These employers may pay or reimburse employees through a QSEHRA for premiums for health insurance that qualify as minimum essential coverage.” Thus the Executive Order would have more impact on larger employers.

 

 
Friday
Oct132017

Friday Five: Top 5 healthcare business news items from the MCOL Weekend edition

Friday Five: Top 5 healthcare business news items from the MCOL Weekend edition
 

Every business day, MCOL posts feature stories making news on the business of health care. Here are five we think are particularly important for this week:

 

Trump to Issue Stop-Payment Order on Health Care Subsidies

In a brash move likely to roil insurance markets, President Donald Trump will "immediately" halt payments to insurers under the Obama-era health care law he has been trying to unravel for months.

The Associated Press

Friday, October 13, 2017

Trump’s Order Advances GOP Go-To Ideas To Broaden Insurance Choices, Curb Costs

The Trump administration Thursday advanced a wide-ranging executive order aimed at expanding lower-cost insurance options, allowing employers to give workers money to buy their own coverage and slowing consolidation in the insurance and hospital industries.

Kaiser Health News

Thursday, October 12, 2017

House Republicans Ramp Up Scrutiny of Providers in Drug Discount Program

House Republicans are intensifying scrutiny of a federal program that gives thousands of safety-net providers hefty discounts on prescription drugs but that they say doesn’t have effective tools to track where the savings are going.

Morning Consult

Wednesday, October 11, 2017

Long-Term Disability Insurance Gets Little Attention But Can Pay Off Big Time

“It won’t happen to me.” Maybe that sentiment explains consumers’ attitude toward long-term disability insurance, which pays a portion of your income if you are unable to work. Sixty-five percent of respondents surveyed this year by LIMRA, an association of financial services and insurance companies, said that most people need disability insurance.

Kaiser Health News

Tuesday, October 10, 2017

Overlooked By ACA: Many People Paying Full Price For Insurance ‘Getting Slammed’

Paul Melquist of St. Paul, Minn., has a message for the people who wrote the Affordable Care Act: “Quit wrecking my health care.” Teri Goodrich, of Raleigh, N.C., has the same complaint. “We’re getting slammed. We didn’t budget for this,” she said.

Kaiser Health News

Monday, October 9, 2017

 

These and more weekly news items on the business of healthcare are featured in the MCOL Weekend edition, along with the MCOL Tidbits, and more, for MCOL Premium level members.

 
Friday
Oct062017

The Impact of Time and Money on The Physician – Patient Relationship

The Impact of Time and Money on The Physician – Patient Relationship
 

by Clive Riddle, October 6, 2017

 

The “physician-patient relationship remains strong but cost may challenge its future,” is the headline takeaway offered by The Physicians Foundation, who just released findings from their second biennial patient survey. Their 45-report discuss analyzes survey responses from a nationally representative sample of 1,747 adults, ages 27-75, who had two visits with the same doctor in the past year.

 

We are told “89 percent of consumers are fearful that the rising cost of healthcare will adversely impact them in the future. In particular, over half (56 percent) of patients say the cost of prescription drugs and pharmaceuticals directly contributes to rising healthcare costs. In fact, because of cost, 25 percent of patients surveyed said they did not fill a prescription and 19 percent have skipped doses of their medicine…..Fifty seven percent of healthcare consumers feel they are one sickness away from being in serious financial trouble. And 75 percent of consumers are concerned with their ability to pay for medical treatment if they were to get sick or injured, an increase from the first survey issued in 2016 when 62 percent were concerned.”

 

What do consumers think is driving increased costs? The Foundation says “eighty-eight percent of consumers look to pharma companies and the way they price drugs as the main reason for rising healthcare costs. Other factors that consumers feel contribute to rising healthcare costs include absence of free markets (24 percent) and fraud (23 percent).” 33% of consumers say they have debt because of medical costs, with 30% of those with debt owing $5,000 or more.

 

Time is the other major concern. The Foundation states that “only 11 percent of patients and 14 percent of physicians report that they have all the time they need together. This signals a significant challenge to providing high quality care, especially when 90 percent of patients feel the most essential element of a quality healthcare system is a solid physician-patient relationship.”

 

The Foundation goes on to report that “65 percent of patients feel that time is always or often limited with the physician, however only half of physicians feel similarly. Yet the same number of patients (53 percent) and physicians (52 percent) are of a common mindset in terms of workload – believing physicians to be at full capacity.” 

 

But despite the pressures from time and money, 95% of patients said they were satisfied with their overall primary doctor relationship, including 64% who said they were very satisfied. 5% said they think about changing their primary doctor all the time, and 15% said they thought about that often.

 
Friday
Oct062017

Friday Five: Top 5 healthcare business news items from the MCOL Weekend edition

Friday Five: Top 5 healthcare business news items from the MCOL Weekend edition
 

Every business day, MCOL posts feature stories making news on the business of health care. Here are five we think are particularly important for this week:

 

Trump Guts Requirement That Employer Health Plans Pay For Birth Control

The Trump administration is rolling back the Obama-era requirement that employer-provided health insurance policies cover birth control methods at no cost to women.

NPR

Friday, October 6, 2017

Association Health Plans: A Favorite GOP Approach To Coverage Poised For Comeback

Not even 24 hours after the latest “repeal and replace” proposal ran out of steam, Sen. Rand Paul (R-Ky.) ignited a new round of health policy speculation by predicting, during a cable news interview, impending Trump administration action on a longtime Republican go-to idea: association health plans.

Kaiser Health News

Friday, October 6, 2017

House passes GOP budget in key step for upcoming tax debate

The House on Thursday passed a $4.1 trillion budget plan that promises deep cuts to social programs while paving the way for Republicans to rewrite the tax code later this year. The 2018 House GOP budget reprises a controversial plan to turn Medicare into a voucher-like program for future retirees as well as the party’s efforts to repeal the “Obamacare” health law.

The Washington Post

Thursday, October 5, 2017

Bill to Rescue Children’s Health Program Hits Snag in House

Legislation to rescue the Children’s Health Insurance Program sailed through a Senate committee on Wednesday, but touched off a partisan conflict in the House, diminishing hopes that the popular program would be quickly refinanced.

The New York Times

Wednesday, October 4, 2017

Cigna says it won’t cover OxyContin prescriptions through employer plans

The health insurer Cigna on Wednesday announced it will no longer cover OxyContin prescriptions for customers on its employer-based health plans, the second major announcement in two weeks from an industry group billed as an effort to slow the opioid epidemic.

Stat News

Wednesday, October 4, 2017

These and more weekly news items on the business of healthcare are featured in the MCOL Weekend edition, along with the MCOL Tidbits, and more, for MCOL Premium level members.